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September 7, 2022

Charted: Just how accurate are telehealth diagnoses?

Daily Briefing

    Telehealth assessments can be just as accurate as those made during in-person visits, with virtual and in-person diagnoses matching almost 90% of the time, according to a new study from Mayo Clinic published in JAMA Network Open.

    The biggest challenges (and untapped opportunities) for telehealth

    How does telehealth diagnoses compare to in-person assessments?

    For the study, researchers examined 2,393 Mayo Clinic patients who received a video telemedicine consultation for a specific clinical problem before following up with an in-person outpatient visit for the same problem between March 24 and June 24, 2020. Among the patients, the median age was 53 years, and 57.7% were female.

    Each provisional diagnosis made through telehealth was compared to the in-person reference standard by two blinded, independent medical reviewers. A multivariate logistic regression model was also used to determine factors related to diagnostic concordance between the two methods.

    Overall, the researchers found that the provisional diagnosis made through a telehealth visit matched the in-person diagnosis in 86.9% of cases. Diagnostic concordance also varied by medical specialty and ICD-10 code chapters.

    Among medical specialties, otorhinolaryngology diagnoses had the lowest concordance at 77.3%, while radiation oncology and hematology oncology had the highest at 100%. For specific conditions in ICD-10 code chapters, ear and mastoid conditions had the lowest concordance at 64.7%, while neoplasms had the highest at 100%.

    In a univariate analysis, researchers found significant differences in diagnostic concordance between specialty care (88.4%) and primary care (81.3%) cases, and surgical (89.6%) and nonsurgical (85.8%) practice settings. However, after adjustment, there was only a significant difference between specialty care and primary care cases.

    In addition, age was negatively associated with diagnostic concordance, with every 10-year increase in age decreasing a patients' odds of receiving a concordant diagnosis by 9%.

    The method of assessment also impacted diagnosis concordance. When an in-person diagnosis could be made by clinician opinion only, concordance between telehealth and in-person diagnoses increased. In comparison, where an in-person diagnosis required confirmatory pathology, a physical examination, or neurological testing, there was a significant decrease in diagnostic concordance.

    According to the researchers, telehealth visits "may benefit from a lowered threshold for timely in-person direct follow-up in patients suspected to have diseases typically confirmed by physical examination, neurological testing, or pathology."

    Overall, "[t]hese findings suggest that video telemedicine visits to home may be good adjuncts to in-person care," the researchers wrote. (Bruce, Becker's Hospital Review, 9/2; Demaerschalk et al., JAMA Network Open, 9/2; JAMA Network Open press release, 9/2)

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